Optimizing an Order Set to Streamline Health Care Delivery in the Emergency Department for Patients Requiring Hiv Post-Exposure Care

Abstract

Background: The Centers for Disease Control and Prevention (CDC) updated guidelines to support efforts to decrease the number of Human Immunodeficiency Virus (HIV) incidences. The principle method for risk reduction utilized in the guidelines is the 28-day non-occupational post-exposure prophylaxis (nPEP) antiretroviral course administered within 72 hours of exposure. Despite this recommendation, adherence to a full 28-day course nPEP is very low nationally. Root cause analysis completed at the study site indicated that the use of an outdated order set caused unwarranted variability in care which accounted for failure in the delivery of appropriate nPEP care and low medication adherence. Order sets are clinical standard tools within computerized provider order entry systems to reduce unwanted variation and improve care processes. Purpose: The purpose of this quality improvement project was to standardize and optimize patient care in accordance with current clinical guidelines through the use of an updated order set. The multidisciplinary approach to quality improvement is viable to ensuring accurate and appropriate evaluation, treatment, follow-up, and prevention of HIV in patients seen in the Emergency Department after an exposure. Evidence-based Intervention: A team of interprofessional experts developed an updated evidence-based nPEP order set that follows current CDC clinical practice guidelines. Implication for Practice: This project aligns the Emergency Department’s nPEP protocol with current best practice and clinical guidelines.